Reply to Jiang et al.

We thank Jiang et al. for their interest and comments on our study about endoscopic screening for second primary tumors (SPTs) in patients with head and neck squamous cell carcinoma (HNSCC) [11]. We agree with the authors that identification of SPT risk factors is important, especially in countries with a relatively low incidence of SPTs compared with Asia [11] [22]. In the current study, we established the yield of endoscopic screening in presumed high risk patients with HNSCC in the Netherlands. Currently, no studies have confirmed whether the identified risk factors in Asia (e.g. alcohol and tobacco use, oropharyngeal or hypopharyngeal tumors, and absence of human papillomavirus [22]) also apply to patients with HNSCC in Western countries. We believe that, after risk factors are identified, future studies should focus on whether screening results in survival benefit and aim to identify the optimal timing of screening in relation to HNSCC diagnosis in Western countries.

Numerous studies have investigated artificial intelligence for several indications during upper gastrointestinal endoscopy, and it can assist in early detection, delineation, and identification of lesions suitable for endoscopic resection [33]. As esophageal SPTs often appear as early and subtle squamous lesions, we agree with Jiang et al. that artificial intelligence might play an important role in detecting these lesions and assist us as endoscopists.

Publication History

Article published online:
28 February 2024

• References

• 1 van Tilburg L, van de Ven SEM, de Jonge PJF. et al. Endoscopic screening of the upper gastrointestinal tract for second primary tumors in patients with head and neck cancer in a Western country. Endoscopy 2023; 55: 981-990
• 2 Bugter O, van de Ven SEM, Hardillo JA. et al. Early detection of esophageal second primary tumors using Lugol chromoendoscopy in patients with head and neck cancer: a systematic review and meta-analysis. Head Neck 2019; 41: 1122-1130
• 3 Tokat M, van Tilburg L, Koch AD. et al. Artificial intelligence in upper GI endoscopy. Dig Dis 2022; 40: 395-408 DOI: 10.1159/000518232. (PMID: 34348267)